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Boulus S, Merlot B, Chanavaz-Lacheray I, Braund S, Kade S, Dennis T, Roman H. Intermittent Self-catheterization for Bladder Dysfunction After Deep Endometriosis Surgery: Duration and Factors that Might Affect the Recovery Process. J Minim Invasive Gynecol 2024; 31:341-349. [PMID: 38325583 DOI: 10.1016/j.jmig.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 01/05/2024] [Accepted: 01/26/2024] [Indexed: 02/09/2024]
Abstract
STUDY OBJECTIVE To assess the duration needed for regaining normal bladder voiding function in patients with postoperative bladder dysfunction requiring intermittent self-catheterization after deep endometriosis surgery and identify risk factors that might affect the recovery process. DESIGN Retrospective study based on data recorded in a large prospective database. SETTING Endometriosis referral center. PATIENTS From September 2018 to June 2022, 1900 patients underwent excision of deep endometriosis in our center; 61 patients were discharged with recommendation for intermittent self-catheterization and were thus included in the study. INTERVENTIONS Intermittent self-catheterization after endometriosis surgery. MEASUREMENTS AND MAIN RESULTS A total of 43 patients (70.5%) stopped self-catheterization during the follow-up period. Median follow-up was 25 weeks (range, 7-223 wk). Surgery was performed laparoscopically in 48 patients (78.7%) and robotically in 13 (21.3%); 47 patients (77%) had nodules involving the digestive tract, 11 (18%) had urinary tract involvement, 29 had parametrial nodules (47.5%), and 13 (21.3%) had sacral plexus involvement. The probability of bladder voiding function recovery and arrest of self-catheterization was 24.5%, 54%, 59%, 72%, and 77% at 4, 8, 12, 52, and 78 weeks, respectively. Cox's multivariate model identified preoperative bladder dysfunction as the only statistically significant independent predictor for arrest of self-catheterization (hazard ratio, 0.36; 95% confidence interval, 0.15-0.83). CONCLUSION Patients requiring intermittent self-catheterization for bladder dysfunction after deep endometriosis excision may spontaneously recover bladder function in 77% of cases. Symptoms suggesting preoperative bladder voiding dysfunction should be reviewed before planning surgery, and patients should be informed of the higher postoperative risk of long-term bladder voiding dysfunction.
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Affiliation(s)
- Sari Boulus
- Franco-European Multidisciplinary Endometriosis Institute, Clinique Tivoli-Ducos (Drs. Boulus, Merlot, Chanavaz-Lacheray, Dennis, and Roman), Bordeaux, France
| | - Benjamin Merlot
- Franco-European Multidisciplinary Endometriosis Institute, Clinique Tivoli-Ducos (Drs. Boulus, Merlot, Chanavaz-Lacheray, Dennis, and Roman), Bordeaux, France; Franco-European Multidisciplinary Endometriosis Institute Middle East Clinic (Drs. Merlot, Kade, and Roman), Burjeel Medical City, Abu Dhabi, United Arab Emirates
| | - Isabella Chanavaz-Lacheray
- Franco-European Multidisciplinary Endometriosis Institute, Clinique Tivoli-Ducos (Drs. Boulus, Merlot, Chanavaz-Lacheray, Dennis, and Roman), Bordeaux, France
| | - Sophia Braund
- Expert Center in Multidisciplinary Endometriosis Management (Dr. Braund), Rouen University Hospital, Rouen, France
| | - Sandesh Kade
- Franco-European Multidisciplinary Endometriosis Institute Middle East Clinic (Drs. Merlot, Kade, and Roman), Burjeel Medical City, Abu Dhabi, United Arab Emirates
| | - Thomas Dennis
- Franco-European Multidisciplinary Endometriosis Institute, Clinique Tivoli-Ducos (Drs. Boulus, Merlot, Chanavaz-Lacheray, Dennis, and Roman), Bordeaux, France
| | - Horace Roman
- Franco-European Multidisciplinary Endometriosis Institute, Clinique Tivoli-Ducos (Drs. Boulus, Merlot, Chanavaz-Lacheray, Dennis, and Roman), Bordeaux, France; Franco-European Multidisciplinary Endometriosis Institute Middle East Clinic (Drs. Merlot, Kade, and Roman), Burjeel Medical City, Abu Dhabi, United Arab Emirates; Department of Gynecology and Obstetrics (Dr. Roman), Aarhus University Hospital, Denmark.
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Roman H, Braund S, Hennetier C, Celhay O, Pasquier G, Kade S, Dennis T, Merlot B. Combined Cystoscopic-Abdominal Versus Abdominal-Only Route for Complete Excision of Large Deep Endometriosis Nodules Infiltrating the Supratrigonal Area of the Bladder: A Comparative Study. J Minim Invasive Gynecol 2024; 31:295-303. [PMID: 38244721 DOI: 10.1016/j.jmig.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 01/04/2024] [Accepted: 01/12/2024] [Indexed: 01/22/2024]
Abstract
STUDY OBJECTIVE Surgical excision of large deep endometriosis nodules infiltrating the bladder may be challenging, particularly when the nodule limits are close to the trigone and ureteral orifice. Bladder nodules have classically been approached abdominally. However, combining a cystoscopic with an abdominal approach may help to better identify the mucosal borders of the lesion to ensure complete excision without unnecessary resection of healthy bladder. This study aimed to compare classical excision of large bladder nodules by abdominal route with a combined cystoscopic-abdominal approach. DESIGN Retrospective comparative study on data prospectively recorded in a database. Patients were managed from September 2009 to June 2022. SETTING Two tertiary referral endometriosis centers. PATIENTS A total of 175 patients with deep endometriosis infiltrating the bladder more than 2 cm undergoing surgical excision of bladder nodules. INTERVENTIONS Excision of bladder nodules by either abdominal or combined cystoscopic-abdominal approaches. MEASUREMENTS AND MAIN RESULTS A total of 141 women (80.6%) were managed by abdominal route and 34 women (19.4%) underwent a combined cystoscopic-abdominal approach. In 99.4% of patients, the approach was minimally invasive. Patients with nodules requiring the combined approach had a lower American Fertility Society revised score and endometriosis stage and less associated digestive tract nodules, but larger bladder nodules. They were less frequently associated with colorectal resection and preventive stoma. Operative time was comparable. The rate of early postoperative complications was comparable (8.8% vs 22%), as were the rates of ureteral fistula (2.2% vs 2.9%), bladder fistula (2.2% vs 0), and vesicovaginal fistula (0.7% vs 2.9%). CONCLUSION In our opinion, the combined cystoscopic-abdominal approach is useful in patients with large bladder nodules with limits close to the trigone and ureteral orifice. These large deep bladder nodules seemed paradoxically associated to less nodules on the digestive tract, resulting in an overall comparable total operative time and complication rate.
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Affiliation(s)
- Horace Roman
- Franco-European Multidisciplinary Endometriosis Institute (Drs. Roman, Dennis, and Merlot), Clinique Tivoli-Ducos, Bordeaux, France; Department of Gynecology and Obstetrics, Aarhus University Hospital, Denmark (Dr. Roman); Franco-European Multidisciplinary Endometriosis Institute - Middle East Clinic, Burjeel Medical City, Abu Dhabi, UAE (Dr. Roman, Kade, and Dr. Merlot).
| | - Sophia Braund
- Expert Center in Diagnosis and Management of Endometriosis, Department of Gynecology and Obstetrics, Rouen University Hospital, Rouen, France (Drs. Braund and Hennetier)
| | - Clotilde Hennetier
- Expert Center in Diagnosis and Management of Endometriosis, Department of Gynecology and Obstetrics, Rouen University Hospital, Rouen, France (Drs. Braund and Hennetier)
| | - Olivier Celhay
- Department of Urology (Dr. Celhay), Clinique Tivoli-Ducos, Bordeaux, France
| | - Geoffroy Pasquier
- Department of Urology, Clinique Mathilde, Rouen, France (Dr. Pasquier)
| | - Sandesh Kade
- Franco-European Multidisciplinary Endometriosis Institute - Middle East Clinic, Burjeel Medical City, Abu Dhabi, UAE (Dr. Roman, Kade, and Dr. Merlot)
| | - Thomas Dennis
- Franco-European Multidisciplinary Endometriosis Institute (Drs. Roman, Dennis, and Merlot), Clinique Tivoli-Ducos, Bordeaux, France
| | - Benjamin Merlot
- Franco-European Multidisciplinary Endometriosis Institute (Drs. Roman, Dennis, and Merlot), Clinique Tivoli-Ducos, Bordeaux, France; Franco-European Multidisciplinary Endometriosis Institute - Middle East Clinic, Burjeel Medical City, Abu Dhabi, UAE (Dr. Roman, Kade, and Dr. Merlot)
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Maurey L, Brasseur-Daudruy M, Elbaz F, Patrier S, Ickowicz V, Braund S, Verspyck E. Echogenic lung: use of high frequency ultrasound and color Doppler to diagnose congenital peripheral bronchial obstruction. Ultrasound Obstet Gynecol 2024. [PMID: 38462991 DOI: 10.1002/uog.27635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 12/26/2023] [Accepted: 02/21/2024] [Indexed: 03/12/2024]
Affiliation(s)
- L Maurey
- Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen, France
| | - M Brasseur-Daudruy
- Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen, France
| | - F Elbaz
- Department of Pediatrics, Rouen University Hospital, Rouen, France
| | - S Patrier
- Department of anatomopathology, Rouen University Hospital, Rouen, France
| | - V Ickowicz
- Department of Obstetrics and Gynecology, Belvedere Hospital, Mont Saint Aignan, France
| | - S Braund
- Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen, France
| | - E Verspyck
- Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen, France
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Braund S, Deneux-Tharaux C, Sentilhes L, Seco A, Rozenberg P, Goffinet F. Induction of labor and risk of postpartum hemorrhage in women with vaginal delivery: A propensity score analysis. Int J Gynaecol Obstet 2024; 164:732-740. [PMID: 37568268 DOI: 10.1002/ijgo.15043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 07/13/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023]
Abstract
OBJECTIVE To explore the association between induction of labor (IOL) and postpartum hemorrhage (PPH) after vaginal delivery. METHODS We included women from the merged database of three randomized prospective trials (TRACOR, CYTOCINON, and TRAAP) that measured postpartum blood loss precisely, with standardized methods. IOL was considered overall and according to its method. The association between IOL and PPH was tested by multivariate logistic regression modeling, adjusted for confounders, and by propensity score matching. The role of potential intermediate factors, i.e. estimated quantity of oxytocin administered during labor and operative vaginal delivery, was assessed with structural equation modeling. RESULTS Labor was induced for 1809 of the 9209 (19.6%) women. IOL was associated with a significantly higher risk of PPH of 500 mL or more (adjusted odds ratio 1.56, 95% confidence interval 1.42-1.70) and PPH of 1000 mL or more (adjusted odds ratio 1.51, 95% confidence interval 1.16-1.96). The risk of PPH increased similarly regardless of the method of induction. The results were similar after propensity score matching (odds ratio for PPH ≥500 mL 1.57, 95% confidence interval 1.33-1.87, odds ratio for PPH ≥1000 mL 1.57, 95% confidence interval 1.06-2.07). Structural equation modeling showed that 34% of this association was mediated by the quantity of oxytocin administered during labor and 1.3% by women who underwent operative vaginal delivery. CONCLUSION Among women with vaginal delivery, the risk of PPH is higher in those with IOL, regardless of its method, and after accounting for indication bias. The quantity of oxytocin administered during labor may explain one third of this association.
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Affiliation(s)
- Sophia Braund
- Université Paris Cité, INSERM U1153, Obstetrical, Perinatal and Pediatric Epidemiology (EPOPé) Research Team, Center for Research in Epidemiology and Statistics (CRESS), Paris, France
- Department of Obstetrics and Gynecology, Charles Nicolle University Hospital, Rouen, France
| | - Catherine Deneux-Tharaux
- Université Paris Cité, INSERM U1153, Obstetrical, Perinatal and Pediatric Epidemiology (EPOPé) Research Team, Center for Research in Epidemiology and Statistics (CRESS), Paris, France
| | - Loïc Sentilhes
- Department of Obstetrics and Gynecology, Pellegrin University Hospital, Bordeaux, France
| | - Aurélien Seco
- Clinical Research Unit of Paris Descartes Necker Cochin, APHP, Paris, France
| | | | - François Goffinet
- Université Paris Cité, INSERM U1153, Obstetrical, Perinatal and Pediatric Epidemiology (EPOPé) Research Team, Center for Research in Epidemiology and Statistics (CRESS), Paris, France
- Department of Obstetrics and Gynecology, Cochin Port-Royal Hospital, APHP, Paris, France
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Leclercq C, Braund S, Verspyck E. [Evolution of the rate of episiotomies and obstetric anal sphincter injuries since the last recommendations of 2018]. Gynecol Obstet Fertil Senol 2024; 52:95-101. [PMID: 38219814 DOI: 10.1016/j.gofs.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 12/29/2023] [Accepted: 01/08/2024] [Indexed: 01/16/2024]
Abstract
OBJECTIVES There is a progressive reduction in the rate of episiotomies since the recommendations of the French college of gynaecologists. Our objective was to study the evolution of the rate of episiotomies and Obstetric Anus Sphincter Injury (OASI) since the restriction of episiotomies in our department. METHODS Observational monocentric retrospective study performed at the Rouen University Hospital. The inclusion criteria were monofetal pregnancies, delivery at a term greater than or equal to 37 weeks of amenorrhea of a living, viable child and by cephalic presentation. We compared two periods corresponding to before and after the 2018 recommendations. We used logistic regression modelling to identify factors associated with the risk of episiotomies and of obstetrical anal injuries, overall and in case of instrumental delivery. RESULTS We included 3329 patients for the 1st period and 3492 for the 2nd period, and the rate of instrumental deliveries were respectively of 16.4% (n=547) and 17.9% (n=626). Multivariate analysis showed a significant decrease in the rate of episiotomies in the 2nd period (OR 0.14, CI 95% [0.12; 0.16], P<0.0001). Main factors associated with the risk of OASI were primiparity (OR 6.21, CI 95% [3.19; 12.11]) and the use of forceps (OR 4.23, CI 95% [2.17; 8.27]) overall; and instrumental delivery using forceps (OR 3.25, CI 95% [1.69; 6.22]) and delivery during the 2nd period (OR 1.98, CI 95% [1.01; 3.88]) in case of instrumental delivery. CONCLUSIONS Our study confirms that the voluntary reduction in the episiotomy rate does not seem to be associated with an increased risk of OASI, overall and in case of instrumental delivery. However, we show an increase in the rate of OASI in case of instrumental delivery since the latest recommendations.
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Affiliation(s)
- Caroline Leclercq
- Service de gynécologie-obstétrique, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France
| | - Sophia Braund
- Service de gynécologie-obstétrique, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France
| | - Eric Verspyck
- Service de gynécologie-obstétrique, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France.
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Verrelli L, Merlot B, Chanavaz-Lacheray I, Braund S, D'Ancona G, Kade S, Dennis T, Roman H. Robotic Surgery for Severe Endometriosis: A Preliminary Comparative Study of Cost Estimation. J Minim Invasive Gynecol 2024; 31:95-101.e1. [PMID: 37935331 DOI: 10.1016/j.jmig.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/09/2023] [Accepted: 11/03/2023] [Indexed: 11/09/2023]
Abstract
STUDY OBJECTIVE To compare the postoperative outcomes and the overall expenses between conventional laparoscopy and robotic surgery, in a series of consecutive patients managed for only severe endometriosis in our institute. DESIGN A cohort comparative study. SETTING Center of Excellence in Multidisciplinary Endometriosis Care. PATIENTS A total of 175 symptomatic patients undergoing surgery for only severe endometriosis from March 2021 to August 2022. INTERVENTIONS We treated patients with endometriosis involving the digestive tract such as rectum, sigmoid colon, and ileocecal junction by rectal shaving, discoid resection, or segmental resection (141 surgeries) with or without bladder (23 surgeries), sacral plexus (19 surgeries), and diaphragm involvements (14 surgeries). MEASUREMENTS AND MAIN RESULTS Postoperative outcomes were evaluated in terms of total surgical time (total surgical room occupancy time and total operating time), hospitalization period, postoperative complications, rehospitalization, and second surgical procedures. A statistically higher total surgical room occupancy (203 minutes vs 151 minutes) and operating time (150 minutes vs 105 minutes) were observed in the robotic group (p = .001). No differences in terms of mean hospital stay (p = .06), postoperative complications (p = .91), rehospitalization (p = .48), and secondary surgical treatment (p = .78) were identified. Concerning the cost analysis only for disposable supply, the cost of colorectal resection was totaled at 2604 euros for the laparoscopic conventional approach vs 2957 euros for the robotic approach (+352.6 euros, +14%). The cost of rectal disc excision was 1527 euros for the laparoscopic conventional approach vs 1905.85 euros (+378 euros, +25%). CONCLUSIONS Our study confirms the feasibility of the robotic approach for the treatment of severe endometriosis, with however a higher cost of robotic approach. Next studies should identify specific indications for robotic surgery, where technical advantages provided by the technology are followed by objective improvement of patients' outcomes.
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Affiliation(s)
- Ludovica Verrelli
- Franco-European Multidisciplinary Endometriosis Institute, Clinique Tivoli-Ducos, Bordeaux, France (Drs. Verrelli, Merlot, Chanavaz-Lacheray, D'Ancona, Dennis, and Roman)
| | - Benjamin Merlot
- Franco-European Multidisciplinary Endometriosis Institute, Clinique Tivoli-Ducos, Bordeaux, France (Drs. Verrelli, Merlot, Chanavaz-Lacheray, D'Ancona, Dennis, and Roman); Franco-European Multidisciplinary Endometriosis Institute Middle East Clinic, Burjeel Medical City, Abu Dhabi, UAE (Drs. Merlot, Kade, and Roman)
| | - Isabella Chanavaz-Lacheray
- Franco-European Multidisciplinary Endometriosis Institute, Clinique Tivoli-Ducos, Bordeaux, France (Drs. Verrelli, Merlot, Chanavaz-Lacheray, D'Ancona, Dennis, and Roman)
| | - Sophia Braund
- Expert Center in Multidisciplinary Endometriosis Management, Rouen University Hospital, Rouen, France (Dr. Roman)
| | - Gianmarco D'Ancona
- Franco-European Multidisciplinary Endometriosis Institute, Clinique Tivoli-Ducos, Bordeaux, France (Drs. Verrelli, Merlot, Chanavaz-Lacheray, D'Ancona, Dennis, and Roman)
| | - Sandesh Kade
- Franco-European Multidisciplinary Endometriosis Institute Middle East Clinic, Burjeel Medical City, Abu Dhabi, UAE (Drs. Merlot, Kade, and Roman)
| | - Thomas Dennis
- Franco-European Multidisciplinary Endometriosis Institute, Clinique Tivoli-Ducos, Bordeaux, France (Drs. Verrelli, Merlot, Chanavaz-Lacheray, D'Ancona, Dennis, and Roman)
| | - Horace Roman
- Franco-European Multidisciplinary Endometriosis Institute, Clinique Tivoli-Ducos, Bordeaux, France (Drs. Verrelli, Merlot, Chanavaz-Lacheray, D'Ancona, Dennis, and Roman); Franco-European Multidisciplinary Endometriosis Institute Middle East Clinic, Burjeel Medical City, Abu Dhabi, UAE (Drs. Merlot, Kade, and Roman); Department of Gynecology and Obstetrics, Aarhus University Hospital, Denmark (Drs. Braund and Roman).
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Géry S, Gromez A, Thoumas JB, Crochet P, Braund S. vNOTES hysterectomy using the lateral window technique in case of a ventrofixed uterus following previous cesarean sections: A video article. J Gynecol Obstet Hum Reprod 2024; 53:102709. [PMID: 38142751 DOI: 10.1016/j.jogoh.2023.102709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 12/26/2023]
Abstract
vNOTES uses the vagina as the surgical channel for endoscopy and achieves improved cosmesis compared to conventional laparoscopy as there are no abdominal incisions. Ventrofixation of the uterus to the abdominal wall following previous cesarean sections further adds to the surgeon's concern of bladder injury. In such cases, a modification of the technique is proposed: introducing the vNOTES port first, before the opening of the vesico-uterine peritoneal folds, thus carried out under endoscopic view. Medial anterior vesico-uterine adhesions are identified and circumscribed by creating a lateral window in the broad ligament on both sides. This allows the cutting of adhesions under endoscopic view to minimize the risk of bladder injuries. The aim of this technical note is to present this modification of the surgical technique for vNOTES hysterectomy in case of ventrofixed uterus.
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Affiliation(s)
- Solène Géry
- Department of Obstetrics and Gynecology, CHU Charles Nicolle, Rouen University, 76000 Rouen, France
| | - Alexis Gromez
- Department of Obstetrics and Gynecology, CHU Charles Nicolle, Rouen University, 76000 Rouen, France
| | - Jean-Baptiste Thoumas
- Department of Obstetrics and Gynecology, CHU Charles Nicolle, Rouen University, 76000 Rouen, France
| | - Patrice Crochet
- Department of Obstetrics and Gynecology, CHU Charles Nicolle, Rouen University, 76000 Rouen, France; Univ Rouen Normandie, INSERM, NORDIC UMR 1239 - Team Adrenal and Gonadal Pathophysiology (AGoPath), 76000 Rouen, France.
| | - Sophia Braund
- Department of Obstetrics and Gynecology, CHU Charles Nicolle, Rouen University, 76000 Rouen, France; Université Paris Cité, INSERM U1153, Obstetrical Perinatal and Pediatric Epidemiology (EPOPé) Research Team, Center for research in Epidemiology and statistic (CRESS), Paris, France
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Verspyck E, Thill C, Ego A, Machevin E, Brasseur-Daudruy M, Ickowicz V, Blondel C, Degré S, Lefebure A, Braund S, Benichou J. Screening for small for gestational age infants in early vs late third-trimester ultrasonography: a randomized trial. Am J Obstet Gynecol MFM 2023; 5:101162. [PMID: 37717697 DOI: 10.1016/j.ajogmf.2023.101162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 09/01/2023] [Accepted: 09/09/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND Recent studies have demonstrated that a routine third-trimester ultrasound scan may improve the detection of small for gestational age infants when compared with clinically indicated ultrasound scans but with no reported reduction in severe perinatal morbidity. Establishing the optimal gestational age for the third-trimester examination necessitates evaluation of the ability to detect small for gestational age infants and to predict maternal and perinatal outcomes. Intrauterine growth restriction most often corresponds with small for gestational age infants associated with pathologic growth patterns. OBJECTIVE This study aimed to assess the performance of routine early ultrasound scans vs late ultrasound scans during the third trimester of pregnancy to identify small for gestational age infants and fetuses with intrauterine growth restriction. STUDY DESIGN This was an open-label, randomized, parallel trial conducted in Upper Normandy, France, from 2012 to 2015. The study eligibility criteria were heathy, nulliparous women older than 18 years with gestational age determined using the crown-rump length at the first trimester routine scan and with no fetal malformation or suspected small for gestational age fetus at the routine second trimester scan. Pregnant women were randomly assigned to a third-trimester scan group at 31 weeks gestational age ±6 days (early ultrasound scan) or at 35 weeks gestational age ±6 days (late ultrasound scan). The primary outcome of this trial was the ability of a third trimester scan to predict small for gestational age infants (customized birth weight <10th percentile) and intrauterine growth restriction (customized birth weight RESULTS Results from 1853 women assigned to the early ultrasound scan group and 1848 women assigned to the late ultrasound scan group were analyzed. The sensitivity was found to be higher in the late ultrasound scan group than in the early ultrasound scan group, both for identifying small for gestational age infants (27%; 22%-32% vs 17%; 13%-22%; P=.004) and intrauterine growth restriction (44%; 35%-54% vs 18%; 11%-27%; P<.001). There was little difference in the specificity between the late ultrasound scan and early ultrasound scan groups in identifying cases of small for gestational age (97%; 96%-98% and 98%; 97%-99%, respectively; P=.04) and intrauterine growth restriction (96%; 95%-97% and 97%; 96%;-97%, respectively; P=.24). Overall, the maternal and neonatal outcomes were comparable between the early ultrasound scan and late ultrasound scan groups with the exception of additional (at least 1) ultrasound scans performed (25% in the early ultrasound scan group vs 19% in the late ultrasound scan group; P<.001). Rates of perinatal death (0.4% vs 0.8%; P=.12) and adverse perinatal outcomes (1.8% vs 2.7%; P=.08) were comparable between the early ultrasound scan and late ultrasound scan assigned groups, and the overall sensitivity to detect small for gestational age infants and intrauterine growth restriction, including in the last ultrasound scan performed before delivery, were also similar (30%; 25%-36% vs 26%; 21%-31%; P=.23; and 50%; 40%-60% vs 38%; 28%-48%; P=.07). CONCLUSION A late ultrasound scan performed in the third trimester increases the probability of detecting small for gestational age infants and intrauterine growth restriction with fewer additional scans reported than for the early ultrasound scan group. The overall perinatal outcome risk was comparable between the 2 groups. However, the overall sensitivity for detecting small for gestational age fetuses and intrauterine growth restriction, including in the last ultrasound scan performed before delivery, remains comparable between the late ultrasound scan and early ultrasound scan groups.
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Affiliation(s)
- Eric Verspyck
- Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen, France (Drs Verspyck, Brasseur-Daudruy, Braund, and Benichou).
| | - Caroline Thill
- Department of Biostatistics, Rouen University Hospital, Rouen, France (Dr Thill)
| | - Anne Ego
- University Grenoble Alpes, CNRS, Public Health Department CHU Grenoble Alpes, Grenoble Institute of Engineering, TIMC-IMAG, 38000 Grenoble, France (Dr Ego); INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), FHU PREMA, Paris Descartes University, Paris, France (Dr Ego)
| | - Elise Machevin
- Department of Obstetrics and Gynecology, Evreux Hospital, Evreux, France (Dr Machevin)
| | - Marie Brasseur-Daudruy
- Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen, France (Drs Verspyck, Brasseur-Daudruy, Braund, and Benichou)
| | - Valentine Ickowicz
- Department of Obstetrics and Gynecology, Belvedere Hospital, Mont Saint Aignan, France (Dr Ickowicz)
| | - Caroline Blondel
- Department of Obstetrics and Gynecology, Mathilde Private Clinic, Rouen, France (Dr Blondel)
| | - Sophie Degré
- Department of Obstetrics and Gynecology, Le Havre Hospital, Le Havre, France (Dr Degré)
| | - Anne Lefebure
- Department of Obstetrics and Gynecology, Elbeuf Hospital, Elbeuf, France (Dr Lefebure)
| | - Sophia Braund
- Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen, France (Drs Verspyck, Brasseur-Daudruy, Braund, and Benichou)
| | - Jacques Benichou
- Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen, France (Drs Verspyck, Brasseur-Daudruy, Braund, and Benichou); Inserm U1018, University of Rouen and University Paris-Saclay, Rouen, France (Dr Benichou); Department of Biostatistics, Rouen University Hospital, Rouen, France (Dr Benichou)
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Braund S, Leviel J, Morau E, Deneux-Tharaux C, Verspyck E. Maternal sudden death: A nationwide retrospective study. BJOG 2023; 130:257-263. [PMID: 36156354 PMCID: PMC10092016 DOI: 10.1111/1471-0528.17294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 08/29/2022] [Accepted: 09/06/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To determine the prevalence of maternal sudden death (MSD) and to compare the characteristics of death between women with explained and unexplained sudden death. DESIGN A national retrospective study in France. POPULATION Maternal deaths related to an unexpected sudden cardiac arrest were extracted from the French National Confidential Enquiry into Maternal Deaths database for 2007-2012. METHODS Maternal, pregnancy, sudden death characteristics and maternal investigations were compared between women with explained and unexplained cause of death. RESULTS A total of 83 maternal sudden deaths and 4 949 890 live births occurred over the period studied, thus accounting for 16% of all maternal deaths (n = 510). Death was explained in 51 (61%) women and unexplained in 32 women (39%). Compared with women with unexplained death, women with explained death were more often found to have in-hospital cardiac arrest (47% versus 12%, P < 0.01), witnessed cardiac arrest (86% versus 62%, P = 0.03) and in-hospital death (82% versus 47%, P < 0.01). Postmortem investigations such as autopsy and/or CT scan (65% versus 31%, P < 0.01) were also more often carried out in women with explained death. The proportion of deaths for which the preventability factors could not be assessed was 58% among unexplained MSD and 7% among explained MSD. CONCLUSION Maternal sudden death is a rare event but accounts for a high proportion of all maternal deaths. This highlights the importance of providing training in diagnostic and management strategy for care providers. Systematic postmortem investigations are required to help understand causes and improve practices.
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Affiliation(s)
- Sophia Braund
- Department of Gynaecology and Obstetrics, Rouen University Hospital, Rouen, France
| | - Juliette Leviel
- Department of Gynaecology and Obstetrics, Rouen University Hospital, Rouen, France.,Department of Gynaecology and Obstetrics, Hospital center Eure Seine, Evreux, France
| | - Estelle Morau
- Department of Anaesthetics, Nîmes University Hospital, Nîmes, France
| | - Catherine Deneux-Tharaux
- Centre for Research in Epidemiology and Statistics (CRESS), Université Paris Cité, INSERM U1153, Obstetrical, Perinatal and Pediatric Epidemiology (EPOPé) Research Team, Paris, France
| | - Eric Verspyck
- Department of Gynaecology and Obstetrics, Rouen University Hospital, Rouen, France
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Roman H, Pontré J, Braund S, Khalil H, Klapczynski C, Hennetier C, Bridoux V, Tuech JJ. Interposition of a biological mesh may not affect the rate of rectovaginal fistula after excision of large rectovaginal endometriotic nodules: a pilot study of 209 patients. Colorectal Dis 2021; 23:2731-2740. [PMID: 34365705 DOI: 10.1111/codi.15855] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 06/25/2021] [Accepted: 07/06/2021] [Indexed: 12/14/2022]
Abstract
AIM The aim of this work was to assess whether placement of a biological mesh (Permacol® ) between the vaginal and rectal sutures reduces the rate of rectovaginal fistula in patients with deep rectovaginal endometriosis. METHOD We report a retrospective, comparative study enrolling patients with vaginal infiltration of more than 3 cm in diameter and rectal involvement in two centres. They benefited from complete excision of rectovaginal endometriotic nodules with or without a biological mesh placed between the vaginal and rectal sutures. The rate of rectovaginal fistula was compared between the two groups. RESULTS Two hundred and nine patients were enrolled: 42 patients underwent interposition of biological mesh (cases) and 167 did not (controls). Ninety-two per cent of cases and 86.2% of controls had rectal infiltration more than 3 cm in diameter. Cases underwent rectal disc excision more frequently (64.3% vs. 49.1%) and had a smaller distance between the rectal staple line and the anal verge (4.4 ± 1.4 cm vs. 6 ± 2.9 cm). Rectovaginal fistulas occurred in 4 cases (9.5%) and 12 controls (7.2%). Logistic regression analyses revealed no difference in the rate of rectovaginal fistula following the use of mesh (adjusted OR 1.6, 95% CI 0.3-9.5). A distance of less than 7 cm between the rectal staple line and the anal verge was found to be an independent risk factor for the development of rectovaginal fistula (adjusted OR 15.1, 95% CI 1.7-132). CONCLUSION Our results suggest that the placement of a biological mesh between the vagina and rectal sutures may not affect the rate of formation of postoperative rectovaginal fistula following excision of deep infiltrating rectovaginal endometriosis.
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Affiliation(s)
- Horace Roman
- IFEMEndo, Clinique Tivoli-Ducos, Bordeaux, France.,Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Sophia Braund
- Expert Center in the Diagnosis and Multidisciplinary Management of Endometriosis, Rouen University Hospital, Rouen, France
| | - Haitham Khalil
- Department of Surgery, Rouen University Hospital, Rouen, France
| | - Clemence Klapczynski
- Expert Center in the Diagnosis and Multidisciplinary Management of Endometriosis, Rouen University Hospital, Rouen, France
| | - Clotilde Hennetier
- Expert Center in the Diagnosis and Multidisciplinary Management of Endometriosis, Rouen University Hospital, Rouen, France
| | - Valérie Bridoux
- Department of Surgery, Rouen University Hospital, Rouen, France
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11
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Bréard H, Pressat Laffouilhere T, Braund S, Levadé R, Perrin M, Machevin E. [If you were to have another abortion, would you choose the same method? A study on 1032 patients' level of satisfaction]. Gynecol Obstet Fertil Senol 2021; 49:511-516. [PMID: 33316439 DOI: 10.1016/j.gofs.2020.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Indexed: 06/12/2023]
Abstract
INTRODUCTION In 2016, the French National College of Gynaecologists and Obstetricians revised the recommandations on abortion care. Abortions can now be medical, regardless of the term, depending on the patients' preference. The aim was to assess the influence of the term and method on patients' satisfaction, in Haute-Normandie. METHOD This is a prospective multicentric study. A questionnaire was completed by patients the day of the hospitalization. The main efficacy parameter was the patient's satisfaction depending on term and method. RESULTS A total of 1032 patients were included from November 2018 till August 2019: 733 medical abortions and 259 surgical abortions. For equivalent terms, medical abortion was associated with a lower satisfaction, OR: 1.9, CI 95 % [1.23; 2.99] P=0.004. For equivalent methods, a term higher than 9 weeks of gestation was also associated with a lower satisfaction OR: 1.56, CI 95 %: [1.09; 2.23], P=0.01. The satisfaction rate was up to 4 out of 5, regardless of the term or the method. For equivalent term and method, an imposed method due to the term was associated with a lower satisfaction OR:3.82, CI 95 % [2.15;6.90], P<0.001. CONCLUSION Term higher than 9 weeks of gestation, medical abortion and an imposed method are associated with a lower satisfaction.
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Affiliation(s)
- H Bréard
- Service de gynécologie obstétrique, hôpital d'Evreux, centre hospitalier Eure-Seine, rue Léon-Schwartzenberg, 27015 Evreux cedex, France.
| | - T Pressat Laffouilhere
- Service de santé publique, CHU de Rouen-Normandie, 37, boulevard Gambetta, 76000 Rouen, France.
| | - S Braund
- Service de santé publique, CHU de Rouen-Normandie, 37, boulevard Gambetta, 76000 Rouen, France.
| | - R Levadé
- Service de santé publique, CHU de Rouen-Normandie, 37, boulevard Gambetta, 76000 Rouen, France.
| | - M Perrin
- Service de santé publique, CHU de Rouen-Normandie, 37, boulevard Gambetta, 76000 Rouen, France.
| | - E Machevin
- Service de gynécologie obstétrique, hôpital d'Evreux, centre hospitalier Eure-Seine, rue Léon-Schwartzenberg, 27015 Evreux cedex, France.
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12
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Klapczynski C, Derbal S, Braund S, Coget J, Forestier D, Seyer-Hansen M, Tuech JJ, Roman H. Evaluation of functional outcomes after disc excision of deep endometriosis involving low and mid rectum using standardized questionnaires: a series of 80 patients. Colorectal Dis 2021; 23:944-954. [PMID: 33320419 DOI: 10.1111/codi.15485] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 10/14/2020] [Accepted: 11/14/2020] [Indexed: 12/26/2022]
Abstract
AIM The aim was to assess the functional outcome and quality of life in patients with low and mid rectal endometriosis who have undergone disc excision using a semicircular transanal staple device, a procedure we have named the Rouen technique. METHODS This was a retrospective study of patients undergoing the Rouen technique between October 2009 and November 2018. Preoperative and postoperative demographic and operative data were recorded prospectively (mean ± SEM). Postoperative complications were recorded using the Clavien-Dindo classification. Rectal function and quality of life were assessed by the low anterior resection syndrome (LARS) and Bowel Endometriosis Syndrome (BENS) scores respectively at ≥6 months. RESULTS The Rouen procedure was performed on 80 patients (29.7 ± 4.3). The mean diameter of resected specimens was 57 ± 10 mm, and the height of the rectal suture from the anal verge was 4.6 ± 1.2 cm. The Clavien-Dindo complications were Clavien-Dindo 1 (leg compression), Clavien-Dindo 2 (urinary tract infection, bladder self-catheterization) and Clavien-Dindo 3b (bowel obstruction, rectovaginal fistula, pyelic dilation, colorectal stenosis after resection). A rectovaginal fistula (Clavien-Dindo 3b) developed in nine (11.3%) patients and their stoma could be reversed after 99-162 days. The majority of patients (n = 50, 62.5%) had normal postoperative rectal function with LARS score ≤20. However, minor (LARS ≥ 21-29) and major rectal dysfunction (LARS ≥ 30) was seen in 18 (22.5%) and 12 (15%) patients respectively. Quality of life as measured using the BENS score was normal (BENS score 0-8) in 51 (63.8%) patients, slightly reduced (BENS score 9-16) in 24 (30%) patients and in only five (6.3%) was this a major issue (BENS score > 17). The development of a rectovaginal fistula was independently related to risk of major rectal dysfunction (adjusted OR 6.3, 95% CI 1.3-30.6). CONCLUSIONS In our series of 80 patients with transmural low and mid rectal endometriosis disc excision using a semicircular staple device can result in good functional outcomes and quality of life and avoid the complexity and potential complications of a low anterior resection.
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Affiliation(s)
- Clémence Klapczynski
- Expert Centre in the Diagnosis and Multidisciplinary Management of Endometriosis, Rouen University Hospital, Rouen, France
| | - Sophiane Derbal
- Department of Digestive Surgery, Rouen University Hospital, Rouen, France
| | - Sophia Braund
- Expert Centre in the Diagnosis and Multidisciplinary Management of Endometriosis, Rouen University Hospital, Rouen, France
| | - Julien Coget
- Department of Digestive Surgery, Rouen University Hospital, Rouen, France
| | | | - Mikkel Seyer-Hansen
- Department of Gynecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark
| | - Jean-Jacques Tuech
- Department of Digestive Surgery, Rouen University Hospital, Rouen, France.,Digestive Tract Research Group EA3234/IFRMP23, Rouen University Hospital, Rouen, France
| | - Horace Roman
- Endometriosis Centre, Clinique Tivoli-Ducos, Bordeaux, France.,Department of Gynecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark
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13
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Klapczynski C, Brasseur-Daudruy M, Hardeman S, Braund S, Verspyck E. [How do I diagnose fetal anal malformations during ultrasound screening?]. ACTA ACUST UNITED AC 2020; 49:288-291. [PMID: 33080396 DOI: 10.1016/j.gofs.2020.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Indexed: 11/15/2022]
Affiliation(s)
- C Klapczynski
- Service de gynécologie-obstétrique, CHU de l'hôpital Charles-Nicolle, 1, rue Germont, 76000 Rouen, France.
| | - M Brasseur-Daudruy
- Service de radiologie pédiatrique et fœtale, CHU de Charles-Nicolle, 1, rue Germont, 76000 Rouen, France
| | - S Hardeman
- Service de gynécologie-obstétrique, centre hospitalier intercommunale Elbeuf-Louviers-Val-de-Reuil, rue du Dr Villiers, 76503 Saint-Aubin-lès-Elbeuf, France
| | - S Braund
- Service de gynécologie-obstétrique, CHU de l'hôpital Charles-Nicolle, 1, rue Germont, 76000 Rouen, France
| | - E Verspyck
- Service de gynécologie-obstétrique, CHU de l'hôpital Charles-Nicolle, 1, rue Germont, 76000 Rouen, France
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Roman H, Chanavaz-Lacheray I, Mircea O, Berby B, Dehan L, Braund S, Verspyck E, Puscasiu L. Large ovarian endometriomas are associated with high pre-operative anti-Müllerian hormone concentrations. Reprod Biomed Online 2020; 42:158-164. [PMID: 33060013 DOI: 10.1016/j.rbmo.2020.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 09/02/2020] [Accepted: 09/08/2020] [Indexed: 12/27/2022]
Abstract
RESEARCH QUESTION Are large ovarian endometriomas associated with high pre-operative anti-Müllerian hormone (AMH) concentrations? DESIGN Data from 332 women who underwent AMH measurement before surgery for endometriosis were prospectively recorded in a large database. Univariate analysis compared AMH concentrations in terms of the patients' baseline characteristics. A multivariate model was used to identify variables having an independent relationship with AMH concentration. RESULTS Among 332 women included in the study, 47.6% were aged 18-30 years, 67.8% were infertile and 85.5% were nulliparous. A total of 66.3% had ovarian endometriomas, and 10.8% had cysts measuring over 6 cm. Bilateral cysts over 3 cm were recorded in 24.7% of the women. Univariate analysis identified two variables that had a statistically significant relationship with AMH concentration: the woman's age (P = 0.01) and cyst size (P < 0.001). Multivariate analysis revealed that ages of 36-40 years and over 40 years showed a significant association with lower AMH concentrations (P = 0.02 and P = 0.009, respectively), while a cyst size of over 6 cm was statistically associated with high AMH concentrations (P < 0.001), after adjustment for smoking, parity, rectosigmoid endometriotic nodules and a bilateral location of endometriomas. CONCLUSIONS Pre-operative AMH concentration was significantly increased in women with large endometriomas of over 6 cm, independent of their age or the presence of bilateral endometriomas. This is relevant for both surgeons and patients when planning surgery in women with an intention to conceive post-operatively.
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Affiliation(s)
- Horace Roman
- Endometriosis Centre, Clinique Tivoli-Ducos, Bordeaux, France; Department of Gynaecology and Obstetrics, University Hospital Aarhus, Aarhus, Denmark.
| | | | - Oana Mircea
- Department of Gynecology and Obstetrics, University of Medicine, Pharmacy, Science and Technology, TarguMures, Romania
| | - Benoit Berby
- Expert Center in Diagnosis and Management of Endometriosis, Department of Gynecology and Obstetrics, Rouen University Hospital, Rouen, France
| | - Lise Dehan
- Expert Center in Diagnosis and Management of Endometriosis, Department of Gynecology and Obstetrics, Rouen University Hospital, Rouen, France
| | - Sophia Braund
- Expert Center in Diagnosis and Management of Endometriosis, Department of Gynecology and Obstetrics, Rouen University Hospital, Rouen, France
| | - Eric Verspyck
- Expert Center in Diagnosis and Management of Endometriosis, Department of Gynecology and Obstetrics, Rouen University Hospital, Rouen, France
| | - Lucian Puscasiu
- Department of Gynecology and Obstetrics, University of Medicine, Pharmacy, Science and Technology, TarguMures, Romania
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Braund S, Hennetier C, Klapczynski C, Scattarelli A, Coget J, Bridoux V, Tuech JJ, Roman H. Risk of Postoperative Stenosis after Segmental Resection versus Disk Excision for Deep Endometriosis Infiltrating the Rectosigmoid: A Retrospective Study. J Minim Invasive Gynecol 2020; 28:50-56. [PMID: 32360656 DOI: 10.1016/j.jmig.2020.04.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 04/23/2020] [Accepted: 04/24/2020] [Indexed: 12/26/2022]
Abstract
STUDY OBJECTIVE To assess the prevalence, risk factors, and management of bowel stenosis after surgery for deep infiltrating endometriosis of the rectosigmoid using either disk excision (DE) or segmental resection (SR). DESIGN Retrospective study using data from consecutive cases recorded in the North-West Inter Regional Female Cohort for Patients with Endometriosis database. SETTING University tertiary referral center. PATIENTS Four hundred thirty-one consecutive patients managed for rectosigmoid endometriosis were enrolled in our study. INTERVENTIONS Laparoscopic SR or DE. MEASUREMENTS AND MAIN RESULTS One hundred sixty-five patients underwent DE, and 266 patients underwent SR. Large nodules ≥3 cm in diameter were more frequent in the SR group (73.3% vs 66.1%), whereas nodules infiltrating the low rectum were 3 times more frequent in the DE group (35.9% vs 11.3%). The frequency of vaginal excision (67.9% vs 62%) and stoma (46.7% vs 44.4%) were comparable between the DE and SR groups. Twenty-three patients presented with postoperative colorectal stenosis after SR (8.6%) versus none after DE (p <.001). Treatment of colorectal stenosis involved dilatation in 20 (87%) cases and SR in 4 (17.4%) cases. For 1 patient, dilatation resulted in rectosigmoid injury requiring SR, followed by rectovaginal fistula. The logistic regression model identified a diverting stoma as the sole risk factor independently related to the risk of postoperative stenosis after SR. CONCLUSION Bowel stenosis after surgery for deep infiltrating endometriosis occurred in patients who underwent SR, most of them with a diverting stoma, whereas no cases of stenosis were reported in patients who underwent DE, with or without stoma.
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Affiliation(s)
- Sophia Braund
- Expert Center in the Diagnosis and Multidisciplinary Management of Endometriosis (Drs. Braund, Hennetier, Klapczynski, and Scattarelli)
| | - Clotilde Hennetier
- Expert Center in the Diagnosis and Multidisciplinary Management of Endometriosis (Drs. Braund, Hennetier, Klapczynski, and Scattarelli)
| | - Clemence Klapczynski
- Expert Center in the Diagnosis and Multidisciplinary Management of Endometriosis (Drs. Braund, Hennetier, Klapczynski, and Scattarelli)
| | - Antoine Scattarelli
- Expert Center in the Diagnosis and Multidisciplinary Management of Endometriosis (Drs. Braund, Hennetier, Klapczynski, and Scattarelli)
| | - Julien Coget
- Department of Surgery (Drs. Coget, Bridoux, and Tuech), Rouen University Hospital, Rouen
| | - Valérie Bridoux
- Department of Surgery (Drs. Coget, Bridoux, and Tuech), Rouen University Hospital, Rouen
| | - Jean Jacques Tuech
- Department of Surgery (Drs. Coget, Bridoux, and Tuech), Rouen University Hospital, Rouen
| | - Horace Roman
- Endometriosis Center, Clinique Tivoli-Ducos, Bordeaux (Dr. Roman), France; Department of Gynecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark (Dr. Roman)..
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Bréard H, Pressat Laffouilhere T, Braund S, Duhamel O, Réal-Lhommet A, Machevin E. [Conflicting recommendations between the French national authority for health (HAS) and clinical practice guidelines (CNGOF); focus on 200 late medical abortions, conducted outside marketing authorizations]. ACTA ACUST UNITED AC 2019; 47:854-859. [PMID: 31626980 DOI: 10.1016/j.gofs.2019.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVES There are conflicting recommandations about late medical abortion: the French National College of Gynaecologists and Obstetricians (CNGOF) and the French Superior Health Authority are opposed. The aim was to assess misoprostol's efficiency in medical abortions at 9 to 14 weeks gestational age (GA) METHODS: This is an epidemiologic retrospective study led from March 2017 till January 2019, in Evreux's hospital, France, including all patients undergoing a medical abortion from 9 to 14 weeks GA. We followed the CNGOF's recommandations published in 2016. The main efficacy parameter was the failure rate of medical abortion at 9 to 14 weeks GA. The secondary efficacy parameters were the number of patients absent at the post-medical abortion examination, the consumption of misoprostol, the consumption of symptomatic treatment, the type of complication and the length of hospital stay. RESULTS 200 patients were included: 19 patients had vacuum aspiration, so we report a 10.2 % failure rate (95% CI: 6.4%; 15.7%). 7 (3.5%) had vacuum aspiration for haemorrhage (2 (1%) receveived a blood transfusion) 9 (4.5%) had a vacuum aspiration for failure and 3 (1.5%) for retention. 71 (35.5%) patients were absent at the post-medical abortion examination. The mean consumption of misoprostol was 1234μg (441). The mean length of hospital stay was 12.2hours (8.28). CONCLUSIONS The abortion failure rate is 10.2%. Our study didn't report any elements of bad tolerance of misoprostol in this indication.
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Affiliation(s)
- H Bréard
- Service de gynécologie obstétrique, CHU de Rouen-Normandie, 37, boulevard Gambetta, 76000 Rouen, France.
| | - T Pressat Laffouilhere
- Service de santé publique, CHU de Rouen-Normandie, 37, boulevard Gambetta, 76000 Rouen, France
| | - S Braund
- Service de gynécologie obstétrique, CHU de Rouen-Normandie, 37, boulevard Gambetta, 76000 Rouen, France
| | - O Duhamel
- Service de gynécologie obstétrique, CHU de Rouen-Normandie, 37, boulevard Gambetta, 76000 Rouen, France
| | - A Réal-Lhommet
- Service de gynécologie obstétrique, CHU de Rouen-Normandie, 37, boulevard Gambetta, 76000 Rouen, France
| | - E Machevin
- Service de gynécologie obstétrique, hôpital d'Evreux, centre hospitalier Eure-Seine, rue Léon Schwartzenberg, 27015 Évreux, France
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